EP3978031A1 - Thérapies à base de transcriptase inverses de la télomérase - Google Patents

Thérapies à base de transcriptase inverses de la télomérase Download PDF

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EP3978031A1
EP3978031A1 EP21198809.2A EP21198809A EP3978031A1 EP 3978031 A1 EP3978031 A1 EP 3978031A1 EP 21198809 A EP21198809 A EP 21198809A EP 3978031 A1 EP3978031 A1 EP 3978031A1
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vector
tert
seq
viral vector
use according
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Maria Bobadilla
Ivan FORMENTINI
Maria Antonia Blasco Marhuenda
Christian Baer
Fatima Bosch Tubert
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Universitat Autonoma de Barcelona UAB
Fundacion del Sector Publico Estatal Centro Nacional de Investigaciones Oncologicas Carlos III FSP CNIO
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Universitat Autonoma de Barcelona UAB
Fundacion del Sector Publico Estatal Centro Nacional de Investigaciones Oncologicas Carlos III FSP CNIO
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    • C12N9/1241—Nucleotidyltransferases (2.7.7)
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    • C12N2750/14011—Parvoviridae
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    • C12N2750/14141—Use of virus, viral particle or viral elements as a vector
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Definitions

  • This invention falls within the field of molecular biology, biotechnology and medicine. More particularly, it relates to compositions and methods useful for the treatment of conditions associated with short telomere length. More particularly, it relates to compositions and methods useful for the treatment of conditions associated with aplastic anemia.
  • telomeres are specialized structures at the ends of chromosomes, which have a role in protecting the chromosome ends from DNA repair and degrading activities ( Blackburn, 2001. Cell 106, 661-673 ; de Lange, 2005. Genes Dev. 19, 2100- 2110 ).
  • Mammalian telomeres consist of TTAGGG repeats bound by a multi-protein complex known as shelterin ( de Lange, 2005. Genes Dev. 19, 2100-2110 ). A minimum length of TTAGGG repeats and the integrity of the shelterin complex are necessary for telomere protection ( Blackburn, 2001. Cell 106, 661-673 ; de Lange, 2005. Genes Dev. 19, 2100-2110 ).
  • Telomerase is a cellular reverse transcriptase (TERT, telomerase reverse transcriptase; also known as TP2; TRT; EST2; TCS1; hEST2) capable of compensating telomere attrition through de novo addition of TTAGGG repeats onto the chromosome ends by using an associated R A component as template (Terc, telomerase RNA component) ( Greider and Blackburn, 1985. Cell 43, 405-413 ). Telomerase is expressed in most adult stem cell compartments, however, this is not sufficient to maintain telomere length as evidenced by the fact that telomere shortening occurs with age in most human and mouse tissues ( Harley et al., 1990. Nature 345, 458- 460 ; Blasco, 2007. Nat Chem Biol. 3, 640-649 ; Flores et al, 2008. Genes and Dev 22, 654-667 ).
  • TERT telomerase reverse transcriptase
  • mice carrying homozygous deletion for the TERC gene lack any detectable telomerase activity and showed progressive telomere shortening from one generation to the other at a rate comparable to the rate reported in human cells (Blasco et al., 1997). Severe phenotypes typical of late generation TERC-/- mice (e.g. bone marrow aplasia and signs of premature aging) could be rescued by re-introducing a copy of the TERC gene (Samper et al., 2001).
  • a virus (AAV) based telomerase gene therapy was found to be beneficial to extend health span, in the context of normal physiological aging in wild-type mice.
  • AAV9-mTERT gene therapy was significantly increased, and aging was decelerated, as indicated by a number of physiological parameters (glucose and insulin tolerance, osteoporosis, neuromuscular coordination, rota-rod, etc).
  • their mean lifespan, compared to control groups was increased by 24% and 13% in adult an old mice, respectively.
  • a single intravenous administration of AAV9-TERT in adult mice resulted in an increase in telomere length in peripheral blood cells (Bernardes de Jesus et al., 2012).
  • Shortened telomeres have been associated with numerous diseases, such as Dyskeratosis congenita, Aplastic anaemia, Myelodysplastic Syndrome, and Fanconi anaemia. Given the severity of these diseases and the poor prognosis of the patients suffering from them, there is a need for novel therapies to treat diseases associated with short telomere length.
  • Aplastic anemia is a potentially life-threatening, rare and heterogeneous disorder of the blood in which the bone marrow cannot produce sufficiently enough new blood cells due to a marked reduction of immature hematopoietic stem (HSC) and progenitor cells (Scopes et al., 1994, Maciejewski et al., 1994). Accordingly, the main disease manifestations are pancytopenia and marrow hypoplasia which can emerge at any stage of life but are more frequent in young people (age 10-25years) and the elderly (>60years) (Marsh et al., 2009). Aplastic anemia can be acquired or inherited.
  • the acquired type is mainly autoimmune-mediated but can also be triggered by environmental factors such as radiation, toxin and virus exposure (Nakao, 1997).
  • the congenital form is rarer, however, mutations in more than 30 genes with functions in DNA repair, ribosome biogenesis and telomere maintenance pathways have been identified to date (Dokal & Vulliamy, 2010).
  • a frequently observed clinical feature of aplastic anemia is short telomere length in peripheral blood leukocytes even in the absence of mutations in the telomere maintenance machinery.
  • Telomeres the termini of vertebrate chromosomes are highly specialised nucleoprotein structures composed of hexanucleotide (TTAGGG) tandem repeat sequences which are bound by a six protein complex ( TRF1, TRF2, TIN2, RAP1, TPP1 and POT1 ) termed shelterin (Blackburn, 2001, de Lange, 2005). These structures are essential for chromosome integrity by preventing telomere fusions and telomere fragility. Telomere length is controlled by the ribonucleoprotein enzyme telomerase which can de novo add telomeric sequences onto telomeres.
  • telomeres Because telomeric sequence is naturally lost upon every cell division (known as the end replication problem) and somatic cells express telomerase at very low levels or not at all telomeres shorten throughout life. When telomeres become critically short they lose their protective function and a persistent DNA damage response at the telomeres is triggered which subsequently leads to a cellular senescence response (Harley et al., 1990, Flores et al., 2008). HSCs, in contrast to most somatic cells, show low level of telomerase activity. However, this activity is insufficient to stop telomere attrition and consequently the regeneration potential of HSCs cells may become limited during the aging process (Hiyama & Hiyama, 2007).
  • telomere lengths In line with this, recipients of bone marrow transplants have shorter telomere lengths than their donors suggesting that telomerase cannot cope with increased replicative proliferation demand during the engraftment phase (Wynn et al., 1998). Moreover, telomeres have been shown to shorten much faster in patients with aplastic anemia compared to the normal aging-related attrition found in healthy individuals potentially owed to a higher than normal number of cell divisions (Ball et al., 1998).
  • tissues with a high proliferative index such as the hematopoietic system are particularly affected by lower than normal telomerase levels which can ultimately lead to severe disorders such as aplastic anemia (Vulliamy et al., 2002).
  • telomeropathy dyskeratosis congenita has been linked to mutations in 7 genes with important functions in telomere maintenance ( TERT, TERC, DKC1, TIN2, NOP10, NHP2 and TCAB1 ) and is characterized by very short telomeres.
  • Dyskeratosis congenita is a multisystem syndrome comprising diverse clinical features such as nail dystrophy, oral leucoplakia, abnormal skin pigmentation and cerebellar hypoplasia (Dokal, 2011).
  • telomere length The causality between proliferation potential and telomere length suggests that a therapeutic intervention with telomerase, aimed at preventing telomere loss beyond a critically short length, may be a feasible strategy to treat those forms of aplastic anemia associated with limited blood forming capacity due to the presence of short telomeres.
  • telomerase aimed at preventing telomere loss beyond a critically short length
  • AAV9 adeno-associated virus
  • telomerase gene therapy using AAV9 Tert in adult wilt-type mice attenuated or reverted the aging-associated telomere erosion in peripheral blood monocytes (Bernardes de Jesus et al., 2012), suggesting that this gene therapy may be effective in the treatment of hematological disorders related to short telomeres.
  • Trf1 the shelterin gene
  • Trf1 cause severe telomere uncapping and provokes a DNA damage response which in turn leads to a fast clearance of those HSCs and progenitor cells deficient for Trf1.
  • Trf1 deletion at a frequency that does not target 100% of the HSCs and progenitor cells. Therefore, cells that retain intact Trf1 undergo additional rounds of compensatory proliferation leading to fast telomere attrition.
  • Trf1 deletion recapitulates the compensatory hyperproliferation observed after bone marrow transplantation or in autoimmune-mediated aplastic anemia, as well as presence of very short telomeres in patients owing to mutations in telomere maintenance genes.
  • Trf1 deletion-mediated HSC depletion allows to control the onset of bone marrow aplasia and pancytopenia (Beier et al., 2012).
  • telomere activation using state of the art gene therapy vectors can be an effective treatment to attenuate telomere attrition and HSC depletion, and thus prevent bone marrow failure.
  • the invention provides compositions and methods useful for the treatment and prevention of conditions associated with short telomere length.
  • One aspect of the invention provides a method of treating a patient with a condition associated with short telomere length comprising administering to the patient a nucleic acid vector comprising a coding sequence for telomerase reverse transcriptase (TERT).
  • TERT telomerase reverse transcriptase
  • the TERT is encoded by a nucleic acid sequence comprising a sequence that is at least 90% identical to the sequence of SEQ ID NO: 1 or SEQ ID NO: 3.
  • the TERT is encoded by a nucleic acid sequence comprising the sequence of SEQ ID NO: 1 or SEQ ID NO: 3.
  • the TERT is encoded by a nucleic acid sequence consisting of the sequence of SEQ ID NO: 1 or SEQ ID NO: 3
  • the TERT comprises an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO:2 or SEQ ID NO: 4.
  • the TERT comprises an amino acid sequence of SEQ ID NO:2 or SEQ ID NO: 4.
  • the TERT consists of the amino acid sequence of SEQ ID NO:2 or SEQ ID NO: 4.
  • the nucleic acid sequence encoding TERT is operably linked to a regulatory sequence that drives the expression of the coding sequence.
  • the vector is a non-integrative vector, such as an adeno-associated virus-based non-integrative vector.
  • the vector is an adeno-associated virus-based vector derived from a serotype 9 adeno-associated virus (AAV9).
  • the capsid of the adeno-associated virus-based vector is made of capsid proteins of the serotype 9 adeno-associated virus (AAV9), and the nucleic acid sequence contained in the capsid is flanked at both ends by internal terminal repeats corresponding to serotype 2 adenoassociated viruses.
  • the nucleic acid contained in the capsid comprises a fragment which encodes the amino acid sequence coding for TERT.
  • the vector comprises a regulatory sequence which is a constitutive promoter.
  • the regulatory sequence is the cytomegalovirus (CMV) promoter.
  • CMV cytomegalovirus
  • the condition associated with short telomere length is characterized by mutations in a gene or genes involved in telomere maintenance.
  • the condition associated with short telomere length is selected from the group consisting of Dyskeratosis congenita, Aplastic anaemia, Myelodysplastic Syndrome, Fanconi anaemia.
  • the invention is directed to the following set of subject matters:
  • the invention provides compositions and methods useful for the treatment and prevention of conditions associated with short telomere length.
  • a "condition associated with short telomere length” is one which is characterized by an accumulation of critically short telomeres.
  • subjects suffering from such a condition exhibit premature onset of pathologies resulting from a defective regenerative capacity of tissues.
  • the condition associated with short telomere length is characterized by mutations in a gene or genes involved in telomere maintenance.
  • specific examples of such genetically based conditions include, but are not limited to Dyskeratosis congenita, Aplastic anaemia, Myelodysplastic Syndrome, Fanconi anaemia, and pulmonary fibrosis.
  • Dyskeratosis congenita is a genetically heterogeneous human disease, which is paradigmatic of premature ageing syndromes (Dokal, 2011). DKC is characterised by the presence of short/dysfunctional telomeres owing to mutations in genes related to telomere maintenance, being the most frequently mutated those encoding proteins of the telomerase complex (i.e. TERT, TERC, NOP10, DKC1, NHP2) (Dokal, 2011; Dokal and Vulliamy, 2010; Mason and Bessler, 2011; Savage and Alter, 2008).
  • TIN2 TRF1-interacting protein
  • a component of the shelterin complex which binds and protects mammalian telomeres (Dokal, 2011; Martinez and Blasco, 2011; Walne et al., 2008).
  • a functional telomerase complex and a proper telomere capping structure by the shelterin proteins are required for maintenance and capping of chromosome ends, respectively.
  • Clinical features of patients suffering from DKC include skin abnormalities (i.e. skin hyperpigmentation), signs of premature aging (i.e. hair greying, nail dystrophy, oral leucoplakia, etc), predisposition to cancer, and several other life-threatening conditions, including aplastic anemia and pulmonary fibrosis (Armanios and Blackburn, 2012).
  • tissues with a high proliferative index are most affected due to the loss of telomeric DNA that occurs upon each cell division. This explains why DKC patients are particularly vulnerable to impaired bone marrow function leading to pancytopenia and eventually bone marrow failure (BMF) (Armanios and Blackburn, 2012; Blasco, 2007)
  • Aplastic anaemia is a life threatening bone marrow disorder characterised by hypocellular bone marrow and low blood cell counts. Patients with acquired aplastic anaemia present with leukocytes which have considerably shorter telomeres than age-matched healthy individuals (Carroll and Ly, 2009). Aplastic anaemia is frequently caused by an autoimmune mediated attack against hematopoietic stem cells.
  • mutations in the core telomerase components TERT and TERC are the underlying cause in a clinically relevant subpopulation (Yamaguchi et al., 2003; Yamaguchi et al., 2005). Mutations in the core telomerase components TERT and TERC, as well as in the shelterin component TIN2 have been linked to this disease (Savage et al., 2006).
  • Myelodysplastic Syndrome encompasses several bone marrow diseases characterised by ineffective production of the myeloid class of blood cells.
  • MDS patients often report with severe anaemia and cytopenias.
  • AML acute myelogenous leukemia
  • shortened telomeres in patients with MDS suggest that insufficient or hampered telomeric maintenance is causative for the syndrome, only 3 out of 210 cases showed heterozygous TERC mutations in a previous study (Yamaguchi et al., 2003).
  • Fanconi anaemia is a heterogeneous genetic disease caused by mutations in genes involved in DNA repair. Affected individuals display multiple congenital defects and haematological deficiencies at a young age of onset (Kee and D'Andrea, 2012). Manifestations related to the latter however are the predominant symptoms of this syndrome and as the disease progresses can develop into the aforementioned syndromes including aplastic anaemia, MDS and AML. Importantly, patients suffering from FA have been also shown to present shorter telomeres than normal (Gadalla et al., 2010). The facts that mutations causing FA show impaired DNA damage response (DDR) and telomeres are particularly vulnerable to replicative stress may provide an explanation for the observed telomere erosion. In support of this Callen et al. (2002) suggested that in FA patients increased telomere breakage in concert with replicative shortening account for the observed telomere shortening.
  • DDR DNA damage response
  • Pulmonary fibrosis refers to a condition characterised by scarring of the lung tissue. Pulmonary fibrosis can be caused by many factors, including chronic inflammatory processes, infections, environmental compounds, ionizing radiation (for example radiation therapy to treat tumors of the chest), chronic medical conditions (lupus, rheumatoid arthritis). Idiopathic pulmonary fibrosis (IPF) refers to pulmonary fibrosis without an identifiable cause.
  • IPF Idiopathic pulmonary fibrosis
  • the invention provides methods of treating a patient suffering from a condition associated with short telomere length comprising administering to the patient an agent which increases the telomere length of the patient.
  • the agent prevents degradation of the chromosomal ends.
  • the agent increases the activity of telomerase reverse transcriptase (TERT).
  • the method of treatment is a gene therapy method comprises administering to the patient a nucleic acid vector comprising a coding sequence for telomerase reverse transcriptase (TERT).
  • the TERT sequence used in the gene therapy vector is derived from the same species as the subject.
  • gene therapy in humans would be carried out using the human TERT sequence.
  • Gene therapy in mice would be carried out using the mouse TERT sequence, as described in the examples.
  • the TERT is encoded by the nucleic acid sequence as set forth in SEQ ID NO: 1 or SEQ ID NO: 3 (human TERT variants 1 and 2), or is an active fragment or functional equivalent of SEQ ID NO: 1 or SEQ ID NO: 3.
  • the polypeptide sequence encoded by SEQ ID NO: 1 is set forth in SEQ ID NO: 2.
  • the polypeptide encoded by SEQ ID NO: 3 is set forth in SEQ ID NO: 4.
  • “functional equivalent” refers to a nucleic acid molecule that encodes a polypeptide that has TERT activity or a polypeptide that has TERT activity.
  • the functional equivalent may displays 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99%, 100% or more activity compared to TERT encoded by SEQ ID NO: 1 or SEQ ID NO: 3.
  • Functional equivalents may be artificial or naturally-occurring. For example, naturally- occurring variants of the TERT sequence in a population fall within the scope of functional equivalent. TERT sequences derived from other species also fall within the scope of the term "functional equivalent", in particular the murine TERT sequence given in SEQ ID NO: 5.
  • the functional equivalent is a nucleic acid with a nucleotide sequence having at least 75%, 80%>, 85%, 90%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9% identity to SEQ ID NO: 1 or SEQ ID NO: 3.
  • the functional equivalent is a polypeptide with an amino acid sequence having at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9% identity to SEQ ID NO: 2 or SEQ ID NO: 4.
  • sequence identity should be calculated along the entire length of the nucleic acid.
  • Functional equivalents may contain one or more, e.g.
  • nucleotide insertions, deletions and/or substitutions when compared to SEQ ID NO: 1 or SEQ ID NO: 3.
  • the term "functional equivalent” also encompasses nucleic acid sequences that encode a TERT polypeptide with at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9% sequence identity to the sequence as set forth in SEQ ID NO:2 or SEQ ID NO: 4, but that show little homology to the nucleic acid sequence given in SEQ ID NO: 1 or SEQ ID NO: 3 because of the degeneracy of the genetic code.
  • active fragment refers to a nucleic acid molecule that encodes a polypeptide that has TERT activity or polypeptide that has TERT activity, but which is a fragment of the nucleic acid as set forth in SEQ ID NO: 1 or SEQ ID NO: 3 or the amino acid sequence as set forth in SEQ ID NO: 2 or SEQ ID NO: 4.
  • An active fragment may be of any size provided that TERT activity is retained.
  • a fragment will have at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, 99.5%, 100% identity to SEQ ID NO: 1-4 along the length of the alignment between the shorter fragment and SEQ ID NO: 1-4.
  • Fusion proteins including these fragments can be comprised in the nucleic acid vectors needed to carry out the invention.
  • an additional 5, 10, 20, 30, 40, 50 or even 100 amino acid residues from the polypeptide sequence, or from a homologous sequence may be included at either or both the C terminal and/or N terminus without prejudicing the ability of the polypeptide fragment to fold correctly and exhibit biological activity.
  • Sequence identity may be calculated by any one of the various methods in the art, including for example BLAST ( Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ (1990). "Basic local alignment search tool”. J Mol Biol 215 (3): 403-410 ) and FASTA ( Lipman, DJ; Pearson, WR (1985). "Rapid and sensitive protein similarity searches”. Science 227 (4693): 1435-41; http ://fasta.bioch. Virginia, edu/ fasta_www2/ fasta_list2. shtml ) and variations on these alignment programs.
  • the method of treatment is a gene therapy method and/or the nucleic acid vector used is a gene therapy vector.
  • Gene therapy methods and vectors are well known in the art and generally comprise delivering a nucleic acid encoding a therapeutically active protein to a subject.
  • the nucleic acid may be delivered in a number of ways including delivering naked DNA such as plasmid or mini-circles, the use of liposomes or cationic polymers or other engineered nano-particles containing the nucleic acid, or viral vectors that encapsidate the nucleic acid.
  • the gene therapy is achieved using stable transformation of organisms with an inducible expression system.
  • Suitable inducible expression systems include the CRE-LOX recombinase based system which is suitable for use in mice and tetracycline-regulated which can be used in the treatment of human subjects.
  • the gene therapy vector is a viral vector.
  • Viral gene therapy vectors are well known in the art. Vectors include integrative and non-integrative vectors such as those based on retroviruses, adenoviruses (AdV), adeno- associated viruses (AAV), lentiviruses, pox viruses, alphaviruses, and herpes viruses.
  • non-integrative viral vectors such as AAV
  • AAV a non-integrative viral vectors
  • the vectors target to adult tissues, avoiding having the subjects under the effect of constitutive telomerase expression from early stages of development.
  • non-integrative vectors effectively incorporate a safety mechanism to avoid over-proliferation of TERT expressing cells. Cells will lose the vector (and, as a consequence, the telomerase expression) if they start proliferating quickly.
  • non-integrative vectors include those based on adenoviruses (AdV) in particular gutless adenoviruses, adeno-associated viruses (AAV), integrase deficient lentiviruses , pox viruses, alphaviruses, and herpes viruses.
  • AdV adenoviruses
  • AAV adeno-associated viruses
  • the non-integrative vector used in the invention is an adeno-associated virus- based non-integrative vector, similar to natural adeno-associated virus particles.
  • AAV preferentially targets post-mitotic tissues, which are considered more resistant to cancer than the highly proliferative ones.
  • Examples of adeno-associated virus-based non integrative vectors include vectors based on any AAV serotype, i.e.
  • Tissue specificity is determined by the capsid serotype. Pseudotyping of AAV vectors and capsid engineering to alter their tropism range will likely be important to their use in therapy.
  • AAVs adeno-associated viruses
  • AAV vectors transduce post-mitotic cells and can sustain long-term gene expression (up to several years) both in small and large animal models of disease ( Niemeyer, Herzog et al Blood 2009 ; Mas, Montane et al Diabetes 2006 ; Jiang, Lillicrap et al blood 2006 ; Ghosh, Yue et al Molecular therapy 2007 ; Tafuro, Ayuso et al cardiovascular research 2009 ).
  • AAV2 is the best characterized serotype for gene transfer studies both in humans and experimental models.
  • AAV2 presents natural tropism towards skeletal muscles, neurons, vascular smooth muscle cells and hepatocytes.
  • AAV2 is therefore a good choice of vector to target these tissues, in particular when using the methods or vectors of the invention to treat a condition associated with one of these tissues. For example, treatment of neuromuscular degeneration may be targeted to skeletal muscle and/or neurons in this way.
  • Newly isolated serotypes such as AAV7, AAV8, and AAV9 have been successfully adopted in preclinical studies ( Gao, Alvira et al PNAS 2002 ). Although limited immunologic responses have been detected in human subjects treated with AAV2 or AAV1 against the AAV capsid ( Manno et al Nat Med 2006 ; Mingozzi et al Nat Med 2007 ; Brantly et al PNAS 2009 ; Mingozzi et al blood 2009 ), long term expression of the therapeutic gene is possible depending on the target tissue and the route of administration ( Brantly et al PNAS 2009 ; Simonelli et al mol therapy 2010 ).
  • AAV9 adeno-associated viruses of wide tropism
  • AAV9 viruses have shown efficient transduction in a broad range of tissues, with high tropism for liver, heart and skeletal muscle ( Inagaki et al Molecular Therapy 2006 ) and thus the beneficial effects of gene therapy can be achieved in more tissues.
  • AAV9 vectors have the unique ability to cross the blood-brain-barrier and target the brain upon intravenous injection in adult mice and cats ( Foust et al Nature biotechnology 2009 ; Duque et al Molecular therapy et al 2009 ).
  • the capsid (which is the part of the virus which determines the virus tropism) of the adeno-associated virus- based vector is made of capsid proteins of the serotype 9 adeno-associated virus (AAV9).
  • the polynucleotide sequence packed in the capsid is flanked by internal terminal repeats (ITRs) of an adeno-associated virus, preferably of serotype 2 which has been extensively characterised in the art, and presents a coding sequence located between the ITRs.
  • the nucleic acid preferably codes for a functional TERT polypeptide.
  • the regulatory sequence operatively linked to the TERT coding sequence is the cytomegalovirus promoter (CMV), although other suitable regulatory sequences will be known to those of skill in the art.
  • CMV cytomegalovirus promoter
  • AAV serotype for the capsid protein of the gene therapy vector may be thus based on the desired site of gene therapy. If the target tissue is skeletal muscle, for example, in treating loss of neuromuscular coordination, AAV1- and AAV6-based viral vectors can be used. Both of these serotypes are more efficient at trans fecting muscle than other AAV serotypes. AAV3 is useful for trans fecting haematopoietic cells.
  • viral vectors can be used in the present invention.
  • Any vector compatible with use in gene therapy can be used in the present invention.
  • Heilbronn & Weger (2010) Handb Exp Pharmacol. 197: 143-70 provides a review of viral vectors that are useful in gene therapy.
  • vectors comprising a coding sequence for telomerase reverse transcriptase (TERT) suitable for use in gene therapy are an important point for putting the invention into practice.
  • Suitable gene therapy vectors include any kind of particle that comprises a polynucleotide fragment encoding the telomerase reverse transcriptase (TERT) protein, operably linked to a regulatory element such as a promoter, which allows the expression of a functional TERT protein demonstrating telomerase reverse transcriptase activity in the targeted cells.
  • TERT is encoded by the nucleic acid sequence as set forth in SEQ ID NO: 1 or SEQ ID NO: 3, or is an active fragment or functional equivalent of TERT.
  • gene therapy vector includes within its scope naked DNA molecules such as plasmids or mini-circles, i.e. circular DNA molecules which do not contain bacterial DNA sequences, provided that the TERT coding sequence and its linked regulatory element are inserted in the plasmid, as well as to more complicated systems, such as particles with the structure of virions (viral particles), comprising at least a capsid and at least a polynucleotide sequence, with a size that allows the polynucleotide sequence to be packed within the capsid in a manner similar to that of the native genome of the virus of origin of the capsid.
  • naked DNA molecules such as plasmids or mini-circles, i.e. circular DNA molecules which do not contain bacterial DNA sequences, provided that the TERT coding sequence and its linked regulatory element are inserted in the plasmid, as well as to more complicated systems, such as particles with the structure of virions (viral particles), comprising at least a capsid and at least a polynu
  • the polynucleotide sequence must include a region where the TERT coding sequence and its linked regulatory element are inserted such that the telomerase reverse transcriptase protein can be expressed from that polynucleotide sequence once the viral particle has infected a cell.
  • the gene therapy vector suitable for being used in the invention is a non- integrative vector, such as an adeno-associated virus-based non-integrative vector.
  • a non-integrative vector such as an adeno-associated virus-based non-integrative vector.
  • non-integrative vectors incorporate a safety mechanism to avoid over-proliferation of TERT expressing cells that will lose the vector if the cells start proliferating quickly.
  • the regulatory sequence operatively linked to the TERT coding sequence is the cytomegalovirus promoter (CMV).
  • CMV cytomegalovirus promoter
  • the nucleic acid sequence encoding TERT is operably linked to a regulatory sequence that drives the expression of the coding sequence.
  • regulatory element means a nucleic acid sequence that serves as a promoter, i.e., regulates expression of a nucleic acid sequence operably linked to the promoter.
  • Such "regulatory elements” or “promoters” can control the expression of linked nucleic acid sequences either constitutively or inducible.
  • the regulatory sequence may be a constitutive promoter.
  • An example of a regulatory sequence which is a constitutive promoter is the cytomegalovirus (CMV) promoter.
  • TERT expression persists for a time of several months to several years. In mice, TERT expression was detectable after 5 months. In monkey, gene expression following gene therapy with an AAV- based vector has been detected up to 6 years after treatment and up to 8 years in dogs ( Rivera et al Blood 2005 , and Niemeyer et al blood 2009 ). Frequent repetition of treatment using the methods and vectors of the invention is therefore not necessary.
  • the subject is treated once. In an alternative embodiment, the subject is treated initially, and is then treated again once TERT expression levels decrease by about 50% of those attained immediately following treatment.
  • Treatment may be repeated with the same or alternative vector to maintain the reduction in age-related disorders if necessary, for example annually, or once every 5 years or once a decade.
  • the second and subsequent administrations may be a vector with a capsid derived from a different serotype than that used for the first administration. It is possible that a subject may develop neutralising antibodies to the first gene therapy vector, making it ineffective if administered a second or subsequent time ( Amado et al (2010) Science Translational Medicine 2(21):21ral6 ).
  • the methods of treatment of the invention have the effect of treating and/or preventing conditions associated with short telomere length.
  • the invention refers to a gene therapy method or the use of a nucleic acid vector as described above, for use in the treatment or prevention in a subject of condition associated with short telomere length, including but not limited to genetically based conditions such as Dyskeratosis congenita, Aplastic anaemia, Myelodysplastic Syndrome, Fanconi anaemia, and pulmonary fibrosis.
  • the effectiveness of treatment of the conditions associated with short telomere length can be measured by various methods known in the art.
  • the effectiveness of the treatment is measured by an increase in lifespan of a treated patient suffering from a condition associated with short telomere length as compared to the expected lifespan of an untreated patient suffering from the same condition.
  • the lifespan is extended by 5%, 10%, 15%, 20% or more, with reference to the expected lifespan for a patient suffering from the same condition.
  • the effectiveness of the treatment is measured by a delayed or prevented bone marrow failure in a treated patient suffering from a condition associated with short telomere as compared to the expected onset of bone marrow failure in an untreated patient suffering from the same condition.
  • the delay in the onset of bone marrow failure of a treated patient suffering from a condition associated with short telomere length is extended by 5%, 10%, 15%, 20% or more, with reference to the expected onset of bone marrow failure for an untreated patient suffering from the same condition.
  • the effectiveness of the treatment is measured by an increase in overall fitness of a treated patient suffering from a condition associated with short telomere length treated as compared to the overall fitness of an untreated patient suffering from the same condition.
  • Overall fitness can be determined by measuring physical attributes associated with the particular condition. Examples of such physical attributes include skin abnormalities (such as skin hyperpigmentation), premature aging (such as hair greying, nail dystrophy, oral leucoplakia), and anaemic pallor. Dokal, I. 2011. Hematology Am Soc Hematol Educ Program, 480-486 .
  • an increase in overal fitness can be determined by a decrease in physical attributes associated with the particular condition exhibited by the treated patient.
  • Overall fitness can also be measure by determining the blood count of the patient.
  • increased overall fitness is measured by determining the amount of leukocytes, lymphocytes, thrombocytes in a peripheral blood sample. Higher blood count indicates an increased overall fitness. In certain embodiments, the blood count in a treated patient is increased by 5%, 10%, 15%, 20% or more, with reference to the blood count of an untreated patient suffering from the same condition.
  • the efficacy of the treatment can also be measured by directly determining telomere length in sample taken from the patient.
  • Telomere length can be measured, for example, by using standard hybridization techniques, such as fluorescence in situ hybridization (FISH), Quantitative Fluorescent in situ hybridization (Q-FISH), or High Throughput Quantitative Fluorescent in situ hybridization (HT Q-FISH). (Gonzalez-Suarez, Samper et al. 2001)in a sample taken from the patient, Samples suitable for telomere analysis include bone marrow tissue and blood samples. Telomere length can also be measured as described in Slagboom et al or Canela et al. (2007, PNAS 104:5300-5305 ).
  • samples are taken from the patient undergoing treatment throughout the course of the treatment so that both absolute telomere length and the rate of telomere shortening over the course of treatment can be determined. Samples may be taken every day during the course of treatment, or at longer intervals. In one embodiment, samples are taken once a week, once every two week, once every three weeks, once every 4 weeks, once every five weeks, once every six weeks or longer. Comparison of telomere length can be measured by a comparing the proportion of short telomeres in a sample taken from a patient.
  • the proportion of short telomeres is the fraction of telomeres presenting an intensity below the mean intensity of the sample as measured by a in situ hybridization technique, such as FISH or Q-FISH.
  • the proportion of short telomeres is the fraction of telomeres presenting an intensity 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40% or more below the mean intensity of the sample.
  • the proportion of short telomeres is the fraction of telomeres presenting an intensity 50% or more below the mean intensity of the sample.
  • the proportion of short telomeres is the fraction of telomeres below a certain length, e.g. 8 kb, 7 kb, 6 kb, 5 kb, or shorter In one embodiment, the proportion of short telomeres is the fraction of telomeres 8 kb or shorter . In another embodiment, the proportion of short telomeres is the fraction of telomeres 7 kb or shorter. In another embodiment, the proportion of short telomeres is the fraction of telomeres 6 kb or shorter. In another embodiment, the proportion of short telomeres is the fraction of telomeres 5 kb or shorter. In another embodiment, the proportion of short telomeres is the fraction of telomeres 4 kb or shorter. In another embodiment, the proportion of short telomeres is the fraction of telomeres 3 kb or shorter.
  • the effectiveness of the treatment is measured by a decrease in the proportion of short telomeres in sample taken from a treated patient suffering from a condition associated with short telomere length as compared to a control sample.
  • the proportion of short telomeres in a sample taken from a treated patient is decreased by 10%, 20%, 30%, 40%, 50%, 60%, 70%, or greater as compared to a control sample.
  • the control sample is a sample taken from the same patient prior to the treatment, or taken at an earlier stage of the treatment.
  • the control sample is a sample taken from a patient suffering from the same condition and not provided the treatment.
  • the invention is applied to the subject by administering a pharmaceutical composition comprising an effective amount of any one of the gene therapy vectors compatible with the invention described above.
  • a “pharmaceutical composition” is intended to include the combination of an active agent with a carrier, inert or active, making the composition suitable for diagnostic or therapeutic use in vitro, in vivo or ex vivo.
  • Composition is intended to mean a combination of active agent and another compound or composition, inert (for example, a detectable agent or label) or active.
  • An “effective amount” is an amount sufficient to effect beneficial or desired results. An effective amount can be administered in one or more administrations, applications or dosages.
  • compositions will generally be administered to a subject in aqueous form. Prior to administration, however, the composition may have been in a non-aqueous form. For instance, although some viral vectors are manufactured in aqueous form, then filled and distributed and administered also in aqueous form, other viral vectors are lyophilised during manufacture and are reconstituted into an aqueous form at the time of use. Thus a composition of the invention may be dried, such as a lyophilised formulation.
  • the composition may include preservatives such as thiomersal or 2-phenoxyethanol. It is preferred, however, that the composition should be substantially free from (i.e. less than 5 ⁇ g/ml) mercurial material e.g. thiomersal-free.
  • a physiological salt such as a sodium salt.
  • Sodium chloride (NaCl) is preferred, which may be present at between 1 and 20 mg/ml e.g. about 10+2mg/ml NaCl.
  • Other salts that may be present include potassium chloride, potassium dihydrogen phosphate, disodium phosphate dehydrate, magnesium chloride, calcium chloride, etc.
  • Compositions will generally have an osmolality of between 200 mOsm/kg and 400 mOsm/kg, preferably between 240-360 mOsm/kg, and will more preferably fall within the range of 290-310 mOsm/kg.
  • Compositions may include one or more buffers.
  • Typical buffers include: a phosphate buffer; a Tris buffer; a borate buffer; a succinate buffer; a histidine buffer (particularly with an aluminum hydroxide adjuvant); or a citrate buffer. Buffers will typically be included in the 5-20mM range.
  • the composition may include material for a single administration, or may include material for multiple administrations (i.e. a 'multidose' kit).
  • a preservative is preferred in multidose arrangements.
  • the compositions may be contained in a container having an aseptic adaptor for removal of material.
  • compositions of the invention for use in humans are typically administered in a dosage volume of about 0.5ml, although a half dose (i.e. about 0.25ml) may be administered to children.
  • the invention also provides a nucleic acid sequence encoding a TERT for use in therapy.
  • the invention also provides a nucleic acid vector comprising a coding sequence for telomerase reverse transcriptase (TERT), for use in a method of therapy and a gene therapy vector comprising a coding sequence for telomerase reverse transcriptase (TERT), for use in a method of therapy.
  • the therapy may be treating or preventing a condition associated with short telomere length.
  • the TERT nucleic acid sequence may be the sequence as recited in SEQ ID NO: 1 or SEQ ID NO: 3 or a fragment or functional equivalent thereof.
  • the TERT protein may have a sequence as recited in SEQ ID NO: 2 or SEQ ID NO: 4, or a fragment or functional equivalent thereof.
  • patient refers to a mammal.
  • the patient is a rodent, primate, ungulate, cat, dog, or other domestic pet or domesticated mammal.
  • the mammal is a mouse, rat, rabbit, pig, horse, sheep, cow, domestic cat or dog, or a human.
  • the patient is a human.
  • mice of C57B6 background that are homozygous carrier of a conditional TRF1 transgene (TRF1 flox/flox ) and further are transgenic for the Cre-recombinase under the control of the endogenous and interferon-inducible Mx1 promoter will be used to test the efficacy of the telomerase gene therapy to treat Dyskeratosis congenital (DKC).
  • DKC Dyskeratosis congenital
  • mice One month after transplantation the mice will be injected via their tail vein with 4 ⁇ 10 12 AAV9 genomes carrying the mTERT cDNA under the control of the potent cytomegalovirus promoter (for virus production, see below 3.3).
  • AAV9 lacking the telomerase gene will be injected into a control group.
  • a separate group of animals will be injected with AAV9-eGFP.
  • TRF1 deletion in the bone marrow will be induced by long-term polyinosinic-polycytidylic acid (pI:pC) treatment with intraperitoneal injections every third day.
  • pI:pC acts as immunostimulant and activates Cre expression which in turn leads to TRF1 deletion in approximately 50% of hematopoietic cells (upon each injection) with the above mentioned consequences (see 2).
  • pI:pC treatment animal groups previously infected with AAV9-mTERT and AAV9-empty will not undergo pI:pC treatment to serve as additional control cohorts.
  • telomere shortening owed to compensatory proliferation in the remaining hematopoietic cells which have not lost TRF1, by ectopic expression of telomerase, will be reduced.
  • end point of experiment death of animals.
  • successful telomerase treatment should show improvements with regards to overall fitness of the animals, i.e. no skin abnormalities and no anaemic pallor. The latter goes hand in hand with higher blood counts (leukocytes, lymphocytes, thrombocytes), which will be determined from peripheral blood samples.
  • the efficacy of telomerase expression on the molecular level will include telomere length measurements.
  • AAV based viral vectors for transduction will be generated by triple transfection of HEK293T cells as described in (Matsushita et al., 1998). Briefly, to 80% confluence grown cells are co-transfected with plasmids (1) carrying the expression cassette flanked by the AAV9 viral ITRs, (2) a helper plasmid carrying the AAV rep2 and cap9 genes, and (3) a plasmid carrying the adenovirus helper functions.
  • the expression cassettes harbour murine TERT under the control of CMV promoter plus 3'-UTR (AAV9-mTERT), CMV promoter (AAV9-empty) alone and eGFP under the control of CMV promoter and SV40 polyA signal (AAV9-eGFP).
  • Vectors are purified following an optimised method based on two consecutive cesium chloride gradients (Ayuso et al., 2010). Titres of viral genomes particles are determined by quantitative real time PCR. Viruses can be stably kept at -80°C until infection of animals.
  • RNA from tissues is extracted with Trizol (Life Technologies). RNA samples are DNase I treated and are used as template for a reverse transcription reaction using random primers and Superscript Reverse Transcriptase (Life Technologies), according to the manufacturer's guidelines. Quantitative real-time PCR is performed using an ABI PRISM 7700 (Applied Biosystems), using DNA Master SYBR Green I mix (Applied Biosystems).
  • the primers are the primers:
  • Trf1 lox / lox Mx1-Cre and Trf1 lox / lox Mx1-wt mice were generated previously described (Martinez et al., 2009) ENREF 20 .
  • Trf1 lox / lox Mx1-Cre mice were used as bone marrow donors for transplantation into 8 weeks old lethally (12Gy) irradiated wild-type mice as previously described (Beier et al., 2012, Samper et al., 2002).
  • mice were intraperitoneally injected with polyinosinic-polycytidylic acid (pI:pC; Sigma-Aldrich) (15 ug/g body weight) 3 times per week for a total duration of 5 weeks. Mice were left for an additional week before they were randomly assigned to two groups for the treatment with AAV9 -Tert or AAV9-empty gene therapy vectors. Vectors were administered via tail vein injection at a concentration of 4 ⁇ 10E12 viral genomes per mouse.
  • Viral vectors were generated as described previously (Matsushita et al., 1998) and purified described in (Ayuso et al., 2010). Briefly, vectors were produced through triple transfection of HEK293T. Cells were grown in roller bottles (Corning, NY, USA) in Dulbecco's Modified Eagle's Medium supplemented with FBS (10% v/v) to 80% confluence and then co-transfected with: plasmid-1 carrying the expression cassette for gene of interest flanked by the AAV2 viral ITRs; plasmid-2 carrying the AAV rep2 and cap9 genes; plasmid-3 carrying the adenovirus helper functions (plasmids were kindly provided by K.A.
  • CMV cytomegalovirus
  • AAV9 particles were purified following an optimized method using two caesium chloride gradients, dialysed against PBS, filtered and stored at -80°C until use (Ayuso et al., 2010).
  • Viral genomes particles titres were determined by a standardized quantitative real time PCR method(Ayuso et al., 2014) and primers specific for the CMV sequence:
  • Bone marrow samples (sternum or tibia bone) were fixed in phosphate-buffered 4% formaldehyde and bones after decalcification paraffin embedded. 5 ⁇ m tissue sections were stained with Hematoxylin-Eosin for histological bone marrow assessment. Immunohistochemistry was performed on deparaffinized tissues sections. After antigen retrieval samples were processed with the anti-EGFP antibodies (rabbit anti-EGFP, 1:200; Abcam, ab290). EGFP positive cells were counted in a semi automated way using ImageJ software.
  • Cells were then resuspended in FACS buffer at 20-25 ⁇ 10 ⁇ 6 cell / ml and the antibody cocktail was added as follows: Anti-sca-1-PerCP-Cy5.5 (1:200), lin cocktail-eFluor450 (1:50) (all eBioscience), and anti-c-kit-APC-H7 (1:100) (BD Pharmingen). Cells were incubated for 30 min.
  • DAPI 200 g/mL was added and cells were subsequently sorted in a FACS ARIA IIu (Becton Dickinson, San Jose, CA) into HSCs (lin negatice, sca1 and c-kit positive) and lineage positive (lin positive) fractions.
  • Short-term colony-forming assay was performed by plating 1 ⁇ 10 4 and 2 ⁇ 10 4 freshly isolated mononucleated bone marrow cells (erythrocytes were lysed as described above) in 35-mm dishes (StemCell Technologies) containing Methocult (methylcellulose-based) media (StemCell Technologies) as described in the manufacturer's protocol. All experiments were performed in duplicates and the numbers of colonies formed were counted after 12 days incubation at 37 °C.
  • Peripheral blood was drawn from the facial vein ( ⁇ 50 ⁇ l) and collected into anti-coagulation tubes (EDTA). Blood counts were determined using an Abacus Junior Vet veterinary hematology analyzer.
  • RNA from whole bone marrow extracts or FACS sorted bone marrow cells wass isolated using Qiagen's RNeasy mini kit according to the manufacturer protocol. The optional DNaseI digest was always performed. Quantitative real-time PCR was performed using an ABI PRISM 7700 or QuantStudio 6 Flex (both Applied Biosystems). Primers sequences for Tert and reference genes Act1 and TBP are as follows:
  • telomere probe mix 10 min air-dried and 30 ⁇ l of telomere probe mix added to each slide (10mM TrisCl pH 7, 25mM MgCl2, 9mM citric acid, 82mM Na2HPO4, 70% deionized formamide (Sigma), 0.25% blocking reagent (Roche) and 0.5 mg/ml Telomeric PNA probe (Panagene)), a cover slip added and slides incubated for 3 min at 85 °C, and 2 h at room temperature in a wet chamber in the dark.
  • HT-Q-FISH on peripheral blood leukocytes was done as described (Canela et al., 2007a). Briefly, 120-150 ⁇ l of blood were extracted from the facial vein. Erythrocytes were lysed (Erythrocyte lysis buffer, Qiagen) and 30-90 k leukocytes were plated in duplicate into clear-bottom, black-walled 96-well plates pre-coated for 30 min with 0.001% poly-L-lysine. Plates were incubated at 37°C for 2 h and fixed with methanol/acetic acid (3:1, v/v) 2 ⁇ 10 min and overnight at -20°C.
  • telomere-specific PNA-CY3 probe was used to stain nuclei.
  • TD values were analysed using individual telomere spots (>10,000 telomere spots per sample). The average fluorescence intensities of each sample were converted into kilobase using L5178-R and L5178-S cells as calibration standards, which have stable TLs of 79.7 and 10.2 kb, respectively. Samples were analyzed in duplicate.
  • AAV9-Tert targets bone marrow and hematopoietic stem cells
  • AAV9 vectors to transduce the bone marrow upon intravenous injection by using both a AAV9-EGFP reporter virus, which allows determination of the location and percentage of AAV9-transduced cells, as well as by determining Tert mRNA expression in vivo in different bone marrow cell populations following AAV9-Tert treatment.
  • AAV9-EGFP reporter virus allows determination of the location and percentage of AAV9-transduced cells, as well as by determining Tert mRNA expression in vivo in different bone marrow cell populations following AAV9-Tert treatment.
  • Trf1 deletion can be induced by administration of pl:pC and subsequent expression of the Cre recombinase (Beier et al., 2012).
  • Trf1 deletion by injecting mice 3 times per week with pI:pC for a total period of 5 weeks, at which point these mice start showing signs of aplastic anemia (Beier et al., 2012).
  • mice were subjected to gene therapy treatment with AAV9 -Tert or AAV9-empty control vectors.
  • mice Post mortem histopathologic analysis of bone marrow sections from mice that died during the first 100 days further confirmed the aplastic anemia phenotype.
  • mice presented with severe bone marrow hypo- and aplasia in 2 or all 3 blood lineages. While the diagnosis at the point of death in both groups was marrow bone failure and aplasia the phenotype appeared milder in the AAV9-Tert group compared with the AAV9-empty group as seen by higher bone marrow cellularity.
  • telomere treatment leads to telomere elongation in peripheral blood and bone marrow
  • telomere length in mice treated with telomerase was compared to mice receiving the control vector.
  • HT-Q-FISH technology Canela et al., 2007b
  • telomere length in peripheral blood monocytes was extracted blood at 4 different time points; after bone marrow engraftment (1), after pI:pC treatment (2), 2 months after AAV9 injection (3) and 4 months after AAV9 injection (4).
  • telomere length between time point 1 and 2 in both groups drops by approximately 10kb which is owed to the pI:pC treatment.

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EP21198809.2A 2014-08-08 2015-08-04 Thérapies à base de transcriptase inverses de la télomérase Pending EP3978031A1 (fr)

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EP3485914B1 (fr) 2021-01-13
JP6676262B2 (ja) 2020-04-08
DK3485914T3 (da) 2021-01-25
ES2864731T3 (es) 2021-10-14
CY1124012T1 (el) 2022-05-27
WO2016020345A1 (fr) 2016-02-11
EP3193943B1 (fr) 2019-03-06
US20170232075A1 (en) 2017-08-17
US20240075109A1 (en) 2024-03-07
US11529396B2 (en) 2022-12-20
US20210260169A1 (en) 2021-08-26
HUE053526T2 (hu) 2021-07-28
EP3485914A1 (fr) 2019-05-22
DK3193943T3 (da) 2019-06-11
PL3485914T3 (pl) 2021-08-02
EP3848056B1 (fr) 2024-02-14
SI3485914T1 (sl) 2021-04-30
PT3485914T (pt) 2021-03-16
JP2017524369A (ja) 2017-08-31
HRP20210265T1 (hr) 2021-04-02
ES2729872T3 (es) 2019-11-06

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